Evolve Chapters 32, 33, & 34: Anticancer & Antineoplastic Drugs

The nurse is completing an admission assessment for a patient admitted for treatment with doxorubicin (Adriamycin). The nurse plans to contact the health care provider if the patient is taking which supplement? A. St. John's wort B. Vitamin D C. Goldenrod leaves D. Grapefruit juice

A. St. John's wort St. John's wort may decrease the concentration of doxorubicin (Adriamycin). Use of St. John's wort should be reported to the health care provider.

A patient is prescribed temsirolimus (Torisel) for treatment of breast cancer. Which patient teaching is a priority for this patient? A. "Take this medication only in the morning." B. "Take this medication with a full glass of water." C. "Do not take this medication with grapefruit juice." D. "Take metoclopramide (Reglan) with each dose of this medication."

B. "Take this medication with a full glass of water." Temsirolimus (Torisel) should not be taken with grapefruit juice. Grapefruit juice may alter the exposure of temsirolimus.

The nurse is monitoring a patient receiving doxorubicin. What intervention is a priority for this patient? A. Keeping patient away from crowds B. Administering dexrazoxane C. Administering antiemetic 60 min before infusion D. Encouraging fluids to 3 L/day

B. Administering dexrazoxane Patients receiving doxorubicin need to be monitored for cardiac toxicity. Dexrazoxane is a cytoprotective (chemoprotective) agent that may be given to help prevent cardiac toxicities associated with doxorubicin administration.

The nurse admits a patient diagnosed with metastatic colorectal cancer. The nurse anticipates that the health care provider will order which medication? A. Dasatinib B. Panitumumab C. Bortezomib D. Rituximab

B. Panitumumab Panitumumab (Vectibix) is indicated for the treatment of metastatic colorectal cancer.

The nurse receives an order for a patient to be treated with interferon alpha-2a. The nurse should prepare to administer the medication by which route? (Select all that apply.) Select all that apply. A. Orally B. Topically C. Intramuscularly D. Subcutaneously E. Intravenously

C, D Interferon alpha-2a can be administered by either intramuscular or subcutaneous injection.

A patient is receiving filgrastim. Which assessment finding indicates that the medication has been effective? A. Decreased bleeding B. Absence of bone pain C. Absence of infection D. Absence of headaches

C. Absence of infection Filgrastim increases the production of white blood cells in the bone marrow. The desired patient outcome is that the patient will not contract an infection.

The nurse is caring for a patient who is being treated with interferon alpha-2b. The nurse recognizes that this medication is most frequently used to treat which condition? A. Genital venereal warts B. Multiple sclerosis C. Hairy-cell leukemia D. Chronic hepatitis B

C. Hairy-cell leukemia Interferon alpha-2b is usually ordered for treatment of hairy-cell leukemia.

A patient receiving filgrastim therapy complains of bone pain. What will the nurse do first? A. Call the health care provider. B. Hold the medication. C. Increase the dose of filgrastim. D. Administer the ordered nonopioid analgesic.

D. Administer the ordered nonopioid analgesic. Skeletal bone pain is a consistently observed reaction to the therapy as the bone marrow expands. Nonopioid analgesics generally control the pain.

When teaching a patient receiving paclitaxel, the nurse plans to instruct the patient to monitor for which side effect? A. Vertigo B. Weight gain C. Hypertension D. Arthralgias

D. Arthralgias Myalgias (muscle pains) and arthralgias (joint pains) are a common side effect of paclitaxel that the patient should be prepared to expect.

The patient is prescribed gefitinib (Iressa). The nurse recognizes that this medication will be given A. once daily by IV. B. twice daily by injection. C. twice daily by IV. D. once daily by mouth.

D. once daily by mouth. Gefitinib (Iressa) is designed to be administered once daily by mouth.

The nurse is teaching a pharmacology class about the ways in which biologic response modifiers assist the immune system. Which of the following should the nurse include in the presentation? (Select all that apply.) Select all that apply. A. They inhibit normal cells from changing into cancer cells. B. They modify cancer cells to render them unable to replicate. C. They enhance the immune system's ability to kill abnormal cells. D. They enhance the body's ability to repair or replace damaged cells caused by other cancer treatments. E. They prevent cancer cells from metastasizing.

A, C, D, E Biologic response modifiers assist the immune system by enhancing the immune system's ability to kill abnormal cells. They change cancer cells to make them behave more like healthy cells. They inhibit normal cells from changing into cancer cells. They enhance the body's ability to repair or replace damaged cells caused by other cancer treatments. They prevent cancer cells from metastasizing.

A patient asks, "Why am I getting three drugs for my cancer if they all do the same thing?" What is the nurse's best response? A. "Administering more than one drug prevents drug resistance." B. More than one drug is administered in case you don't respond to one of them." C. "This makes your treatment more cost-effective." D. "We are not sure what drug will be the most effective, so this combination ensures success."

A. "Administering more than one drug prevents drug resistance." Administering a combination of antineoplastic agents allows for smaller doses of each, which can minimize the severity of side effects and help prevent drug resistance.

The nurse prepares to administer aldesleukin to a patient diagnosed with renal carcinoma. Which assessment indicates a therapeutic effect of this medication? A. A decrease in renal tumor size B. A decrease in hemoglobin and hematocrit C. An increase in red blood cells D. An increase in renal tumor size

A. A decrease in renal tumor size Aldesleukin enhances the immune system by stimulating the production and activity of T-cells and decreases the size of renal cell tumors.

The nurse is completing an admission assessment for a patient diagnosed with pancreatic cancer who is prescribed erlotinib. The patient is currently being treated for an infection with clarithromycin. What is the nurse's initial intervention? A. Contact the health care provider. B. Administer acetaminophen (Tylenol). C. Hold the Iressa until the patient's course of clarithromycin is completed. D. Administer diphenhydramine (Benadryl).

A. Contact the health care provider. Clarithromycin inhibits the liver microsomal CYP3A4 enzyme, which increases the blood levels of erlotinib. The health care provider will need to make a decision about starting the medication. Diphenhydramine (Benadryl) is frequently used as a premedication for intravenous chemotherapy; however, this intervention will not be implemented until the health care provider has had an opportunity to decide about starting the erlotinib. Acetaminophen (Tylenol) will likely be avoided with this patient because the patient should be monitored for fever.

The patient is prescribed erlotinib (Tarceva). The nurse recognizes that this medication is most frequently used to treat which cancer? A. Non-small cell lung cancer B. Colorectal cancer C. Hepatocellular cancer D. Metastatic breast cancer

A. Non-small cell lung cancer Erlotinib (Tarceva) is used to treat non-small cell lung cancer as well as pancreatic cancer.

The patient has been ordered gefitinib (Iressa) in the treatment of non-small cell lung cancer. After receiving three doses of the medication, the patient complains to the nurse of experiencing a skin rash. The nurse recognizes that this symptom is indicative of A. an expected side effect of the medication. B. a progression of the cancer. C. an overdosage of the medication. D. an allergic reaction to the medication.

A. an expected side effect of the medication. A skin rash is known to be a side effect that is typically experienced with this medication.

The patient is being treated with interferon gamma. The nurse recognizes that the medication is most frequently used to treat which condition? A. Leukemia B. Chronic granulomatous disease C. Multiple sclerosis D. Malignant melanoma

B. Chronic granulomatous disease Interferon gamma is most often ordered to treat chronic granulomatous disease.

The patient has been ordered treatment with alemtuzumab (Campath). The nurse recognizes that this medication is most often used to treat which cancers? A. Colorectal cancer and head and neck cancers B. Chronic lymphocytic leukemia C. Mantle cell lymphoma and multiple myeloma D. Hepatocellular cancer and advanced renal cell carcinoma

B. Chronic lymphocytic leukemia Alemtuzumab (Campath) is most frequently used to treat chronic lymphocytic leukemia.

The nurse is caring for a patient receiving cyclophosphamide. What is a priority intervention for this patient? A. Assessing blood pressure hourly B. Encouraging fluids before, during, and after drug administration C. Keeping patient isolated until drug is excreted D. Drawing peak and trough levels

B. Encouraging fluids before, during, and after drug administration Patients receiving cyclophosphamide should drink at least 2-3 L of fluid before, during, and after administration to prevent hemorrhagic cystitis.

A patient is nauseated and vomiting after receiving chemotherapy. What is the best nursing intervention? A. Inform the patient that the nausea will pass with time. B. Maintain hydration and nutrition and administer antinausea medications. C. Use antacids to relieve the irritation to the stomach, which should stop the nausea. D. Tell the patient to avoid eating any food during chemotherapy treatments.

B. Maintain hydration and nutrition and administer antinausea medications. It is very important for patients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are available that are very successful in controlling this side effect. The patient will most likely remain nauseated even without food intake.

In order to protect against exposure to chemotherapy drugs when caring for patients receiving intravenous (IV) therapy, what should the nurse do? A. Wear gowns, gloves, masks, and headgear when administering all chemotherapy drugs. B. Wear a disposable gown when administering IV chemotherapy. C. Wear a mask when receiving the drug from the pharmacist. D. Administer IV chemotherapy only under the direct observation of the health care provider.

B. Wear a disposable gown when administering IV chemotherapy. A disposable gown should be worn when administering IV chemotherapy. The combination of gowns, gloves, masks, and headgear is not necessary for all chemotherapy drugs. A mask is not necessary when the pharmacist is preparing the drug. Nurses can administer chemotherapy without the observation of the health care provider.

The patient is being treated with interferon alpha-2b. The patient is currently receiving theophylline as part of the regimen. Which adjustment would the nurse anticipate as a result of the interaction of these two medications? A. A decrease in the dose of interferon alfa-2b B. Addition of an interferon alfa-2a C. A significant decrease in theophylline requiring dose adjustment D. A significant increase in theophylline requiring dose adjustment

C. A significant decrease in theophylline requiring dose adjustment It is unknown whether IFN-α-2b is metabolized by the liver; therefore, caution is advised when IFN-α-2b is taken with other drugs metabolized through the hepatic cytochrome P450 enzyme system. The effect of IFN on the CYP450 system might increase enzyme degradation or inhibit CYP450 system. IFN-α-2b with concomitant use of theophylline may result in a 100% increase in theophylline concentrations, requiring a decrease in theophylline dosage.

A patient is receiving IV cyclophosphamide. Which intervention is a priority for this patient? A. Monitoring the white blood cell count B. Administering an antianxiety agent C. Ensuring that the patient is well hydrated D. Running IV dextrose with the chemotherapy

C. Ensuring that the patient is well hydrated The patient should be well hydrated while taking this drug to prevent hemorrhagic cystitis (bleeding as a result of severe bladder inflammation). Normal saline is used as the maintenance IV when administering chemotherapy. Although it is important to monitor the patient's white blood cell count while receiving chemotherapy, avoiding hemorrhagic cystitis is the priority because it can be life-threatening. Antianxiety agents can be used if needed for the patient but on an individual basis, not routinely.

The patient has been ordered treatment with bortezomib (Velcade). The nurse recognizes that this medication is most often used to treat which cancers? A. Hepatocellular cancer and advanced renal cell carcinoma B. Chronic lymphocytic leukemia C. Mantle cell lymphoma and multiple myeloma D. Colorectal cancer and head and neck cancers

C. Mantle cell lymphoma and multiple myeloma Bortezomib (Velcade) is most frequently used to treat mantle cell lymphoma and multiple myeloma.

The nurse is caring for several patients who are scheduled to receive epoetin alfa (Procrit). The nurse should question the administration of this medication to a patient with which condition? A. Human immunodeficiency virus B. Chronic renal failure C. Uncontrolled hypertension D. Anemia

C. Uncontrolled hypertension Hypertension is a side effect of epoetin alfa (Procrit); hence, the drug should not be given to patients with uncontrolled hypertension. Anemia, chronic renal failure, and human immunodeficiency virus or acquired immunodeficiency syndrome are indications for the therapeutic use of epoetin.

The nurse is caring for a patient receiving high-dose methotrexate (MTX) therapy. What intervention is a priority for this patient? A. Administering bleomycin immediately after treatment with MTX B. Encouraging oral fluids to 4 L/day while being treated with MTX C. Infusing IV dextrose at 100 mL/h throughout the drug therapy D. Administering leucovorin within 2 days of treatment with MTX

D. Administering leucovorin within 2 days of treatment with MTX Leucovorin calcium is given within the first 24-42 h of starting methotrexate to block the systemic toxic effect of high-dose MTX. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist. Bleomycin is not administered with MTX; IV dextrose is not necessary with MTX therapy, and increased fluids to this degree are not necessary with MTX.

The nurse is caring for a patient who has been diagnosed with metastatic breast cancer. The nurse receives an order to administer dasatinib (Sprycel). What is the nurse's priority action? A. Start an IV as part of preparing to administer the medication. B. Contact the pharmacist regarding administering the medication. C. Administer ordered premedications prior to giving the drug. D. Contact the health care provider regarding the medication.

D. Contact the health care provider regarding the medication. The nurse should contact the health care provider regarding use of this medication, since it is most frequently ordered to treat leukemia rather than metastatic breast cancer.

The nurse is caring for a patient who has been ordered a treatment regimen for colorectal cancer. The nurse brings the consent form to the patient to sign prior to initiating the treatment, and the patient tells the nurse, "I really don't understand why I can't be treated with vitamins and nutritional therapy." What is the nurse's priority action? A. Encourage the patient to sign the consent form. B. Schedule an instructional session with the dietician. C. Discuss the treatment regimen with the pharmacist. D. Contact the health care provider.

D. Contact the health care provider. The health care provider should be contacted since the patient cannot sign the informed consent form for treatment. It is the health care provider's responsibility, not the pharmacist's nor the dietician's, to make certain that the patient understands the reason for treatment. The nurse should not encourage the patient to sign the consent form when the patient does not understand the reason for treatment.

The nurse is caring for a patient with a hemoglobin of 15 g/dL, platelet count of 450,000/mm3, and thrombocyte count of 8,000/mm3 who is to receive cyclophosphamide therapy. What is the nurse's priority intervention? A. Teach the patient effects of chemotherapy. B. Isolate the patient. C. Start platelet transfusion. D. Hold the cyclophosphamide therapy.

D. Hold the cyclophosphamide therapy. Cyclophosphamide causes bone marrow suppression, which is evidenced by a decrease in red blood cells, white blood cells, and platelets. A thrombocyte count of 8000/mm3 is significantly lower than normal. The chemotherapy should be held.

The nurse is caring for a patient who is being treated with interferon beta-1b. The nurse recognizes that the medication is most frequently used to treat which condition? A. Chronic myelogenous leukemia B. Hairy-cell leukemia C. Malignant melanoma D. Relapsing multiple sclerosis

D. Relapsing multiple sclerosis Interferon beta-1b is most often ordered to treat relapsing multiple sclerosis.

The nurse is caring for several patients receiving chemotherapy. What patient will the nurse assess first? A. The patient receiving fluorouracil (with an elevated platelet count) B. The patient receiving doxorubicin with a history of angina C. The patient taking cyclophosphamide who is urinating 100 mL/h D. The patient receiving mechlorethamine with pain at the IV insertion site

D. The patient receiving mechlorethamine with pain at the IV insertion site Mechlorethamine (nitrogen mustard) is a severe vesicant and can cause tissue necrosis if it infiltrates into the tissues. Pain at the IV site is an indication of possible infiltration and needs to be addressed. History of angina is a concern because Adriamycin is cardiotoxic; however, this patient is not the priority.